by Penney Cowan, Executive Director, ACPA

1

JUNE 2011

I N S I D E2 Meditation and

Chronic Pain

5 Mindfulness isAbout Making theMinutes Matter

7 Self-HypnosisTechniques forRelaxation

9 Members’ Forum

10 Why AttitudeMatters

11 Book Review

12 For Our VIPS:Veterans In Pain

12 Medical andResearch News

13 ACPA Updates

14 New Groups andTributes

The Connection betweenMindfulness and Pain

People with pain struggle far too often to validate their pain.Physical pain brings life to a

screeching halt and prevents us fromgoing about our daily lives or makingfuture plans. It is the physical pain that is the root cause and controllingfactor—pain and nothing else. Right?

Certainly pain has an impact on ourphysical being. We struggle to completethe simplest of tasks, hampered by areduced energy level that is limited to small bursts of time, sometimes notmore than a few minutes. We hesitateto plan for tomorrow, let alone thefuture. Activities with friends and family diminish and far too often disappear as we find ourselves isolatedand alone . . . and in pain. It is thepain that restricts our ability to function, right?

But once you begin your journey from patient to person, working withan interdisciplinary health care team,your doctors and providers will talkabout stress management, biofeedback,counseling, group therapy, and otherways to explore your emotions. Youmay react by thinking that your problem isn’t emotional, it’s physical.You may think, “My pain is real. I’m not exaggerating this suffering.”

That is how I felt when I heard aboutdepression, emotions, and counseling.I was not crazy, just in pain! Whowouldn’t be depressed if his life was controlled by pain?

However, I have learned a great dealsince I left the pain program at theCleveland Clinic 32 years ago. As Ibegan my journey back to a person I realized that, although my pain isreal, it controls my emotional being as much as it does my physical being.They are connected in so many ways.

Listen to Your BodyOne of the most important skills Ilearned in pain management was to listen to my body. Before that, I would ignore the little signs ofincreased stress, tension, and pain and not hear my body’s voice until it was screaming at me.

When this happens, we give in to the pain and avoid doing that pain-inducing activity again. Over time, we realize that we have eliminatedmany activities in our life.

Join Us onFacebook

C O N T I N U E D O N P A G E 6 . . .

This issue of the ACPA Chronicle is funded by

Taking Life Moment by Moment: Meditation and Chronic Pain

You may have heard that medita-tion can help relieve stress andreduce pain. But how does the

practice live up to its reputation? Theexperiences of two ACPA facilitatorsshow that although learning mindfulnesswas part of the journey from patient toperson, there are many paths to thatgoal.

“Meditation teaches you how to use your breath, and that was the first lesson I needed to learn,” says CherylNeuenschwander, an ACPA facilitatorfrom Stockton, California. “Most peoplewith pain, stress, or anxiety breathe shallowly, in their chests, but you’re supposed to breathe through your belly,”Neuenschwander explains. “I had livedwith anxiety most of my life, even before I had chronic pain,” she says.

Her meditation class taught that breathing could be a tool to relax the body and calm the mind and how to let thoughts surface naturally, but not to dwell on them.

“I’m learning to live my life in aware-ness,” Neuenschwander says. She saysthat activities as mundane as emptyingthe dishwasher can be a mindfulnessexercise. “If you pay attention to whatyou’re actually doing—taking the dish,holding it in your hand, placing it precisely on the shelf—you don’t think of it as a chore or as something youhave to get through,” she says.

Live in the Moment, Not the Future or PastLiving in the moment can be a helpfultechnique when dealing with pain. “Youcan survive almost anything if you livemoment to moment,” points out PatriciaHubert, a nurse who leads ACPA groupsin Summit, New Jersey. “If you thinkabout the implications of what you’redealing with, it looms too large.”

Hubert points out that people with paincan be their own worst enemies becauseit’s difficult to separate the physical painof the moment from the emotional pain(past, present and future) caused by itsimpact on their lives. “Pain is a naturalpart of life, but suffering is only onepossible response to pain and we canhelp ourselves to suffer less,” she says.“People with chronic illness have a storyabout all the things that have happenedto us,” she says. “It’s important to tellthat story, but you can’t stay focused onit. You have to focus on the rest of yourlife. I’m still Pat, I still think the sameway, and I’m still capable of the samethings mentally.”

Hubert says she’s managed whole daysfrom moment to moment, task to task. “I don’t think about everything I have todo that day; that would be overwhelm-ing. Instead I think, ‘I just have to get

through breakfast.’ Then when I’m donewith that, I think, ‘I just have to getthrough a shower.’ ”

Mindfulness teaches you to accept whatis and not worry about what it mightmean. Neuenschwander says she usesmeditative techniques to help her handleall sorts of situations. “If I’m driving andI come upon some traffic, I can call onmeditation techniques to calm myself,”Neuenschwander explains. “And insteadof worrying about a traffic jam, I canjust notice that there are a lot of cars in the road; that’s not a problem.”

Normally, traffic brings up negativethoughts that are based in the past or the future—like anger over havingchosen the wrong route or anxiety aboutarriving late. Taking just what exists inthe moment (a lot of cars on the road) at its face value, without assigning valuesor implications, can make traffic muchless stressful.

Reduce Stress to Reduce PainStress reduction of any type has benefitsfor people with chronic pain. “Whenyou’re stressed, your cortisol levels rise, and your muscles tighten up,” says Hubert. “Stress makes everythingworse, especially for people who haveany kind of musculoskeletal pain.”

Hubert began studying mindfulness andmeditation as part of a stress reductionclass offered nearby. Both she andNeuenschwander took courses based on the work of Jon Kabat-Zinn, Ph.D., a researcher and author who founded the Center for Mindfulness in Medicine, Health Care, and Society.Neuenschwander’s course, part of achronic pain treatment program, focused on mindfulness as a way to combat depression.

Hubert says that Kabat-Zinn’s approachappealed to her partly because there was research to back it up. “He did studies starting in the late 1970s at

2

by Erin Kelly

| TOP |C O N T I N U E D O N P A G E 3 . . .

3

Massachusetts General that showed that stress relief can help healing anddecrease pain,” she says. “As a master’s-prepared nurse, I liked knowing that.”She says that Kabat-Zinn has studiedmeditation’s potential role in helpingpeople heal from cardiac surgery andchronic illnesses as well as in helpingmanage stress, depression, anxiety, andchronic pain.

Hubert’s education in mindfulnessbegan at one of the roughest times inher life. Her pain was very bad and she hadn’t yet found the doctors andtreatments that would help her. Hermother was gravely ill and caring forher in the hospital was a physical andemotional strain. And she was helpingher daughter in Arizona to plan a wedding in Florida. A friend convincedher to sign up for a course called“Mindfulness-Based Stress Reduction” at the University of Massachusetts. “I was so stressed and busy I couldn’tmake it to class until it was half over,”she explains. “I knew I shouldn’t havecome. But when the class saw me, theyknew that I needed to come!”

Despite her significant pain and stresswhen she started learning meditation,Hubert found it helpful within the firstfew weeks. “During that time in classwhen we were doing the exercise, I wasable to feel better,” Hubert says. “I wascontrolling my reaction to my pain.”

Neuenschwander did not have suchquick results, but she was tenacious anddetermined to find a solution to her latest pain setback. “I had started havingmigraines with head and face pain andnothing was helping me. By 6 p.m. everyday I had to shut down,” she says. “Iwas bound and determined that thiswas going to work, so every night at sixwhen I gave up and went to bed, I wentto bed with my iPod and the meditationprogram on!” It took almost a year, butNeuenschwander says that eventually itmade “all the difference in the world.”

Finding the Right Approach Part of the problem for both women wasfinding the right approach, since thereare many different types of meditation.“I had tried visualization before, thetapes where you imagine yourself walking in a beautiful garden,”

Neuenschwander says, “but that didn’t do anything for me.”

Hubert’s experience is different; she says she does benefit from that kind ofmeditation exercise and uses it in hersupport groups as a relaxation exercise.“There are other techniques that are useful too,” Hubert points out, “likebody scans, where you focus on eachpart of the body and relax them one at a time,” she says. “Lamaze childbirthclasses teach a similar technique,” shepoints out.

Although meditation is frequently associated with “New Age” philosophyand eastern religions, it’s also part ofChristian and Jewish traditions. Manypeople find that mindfulness meditationfits into their existing religious practice.A member of one of Neuenschwander’sgroup practices a faith-based meditationin which “she places everything in God’shands,” Neuenschwander explains. “Shesays her outlook on her pain has completely changed.”

The meditation techniques that Hubertand Neuenschwander use encouragethem to acknowledge physical pain, like any other sensation. “If you’re doinga body scan and something hurts, younotice that, without judging it, and thenyou return to focusing on your breath,”explains Hubert.

Neuenschwander agrees. “We hate ourpain, but we can’t fight it—bracingagainst it just causes more pain. Weneed to face it, and almost treat it withkindness, so that we become resilient toit,” Neuenschwander explains. “You can’tkeep thinking about how you’re sick ofbeing in pain, because that gets youcaught up in negativity and anger.”Instead, she acknowledges and acceptsher pain but moves on. “I say to myself,okay, there’s that neck again. There it is.I’ll just breathe.”

C O N T I N U E D O N P A G E 4 . . .

“We hate our pain, but we can’t fight it –bracing against it just causes more pain. We need to face it,

and almost treat it with kindness, so that we become resilient to it.”

| TOP |

C O N T I N U E D F R O M P A G E 2 . . .

Refocusing Thoughts for a New OutlookNeuenschwander acknowledges that herwhole mindset is different since learningthese tools. “Before, my thoughts werereally like self-torture, continuously projecting the future. I just created morefear and anxiety about my pain. I was soagitated.” She says that her calmer frameof mind has changed her relationships.“I tell people they don’t have to watchwhat they say around me so much,” she says. “I’m not as reactive as I used to be.”

Hubert also says that her outlook haschanged since she began studying mind-fulness. “I notice it when I’m talking tomy husband about something stressful,”she explains. “Since I took the course, it’s

much easier for me to let things go andI can see how much he makes himselfupset,” she says. “I tell him ‘there’s nothing you can do about it; don’t let it ruin your evening!’ ”

Both Hubert and Neuenschwander are excited to learn more about howthey can help themselves stay healthy.“There’s so much we don’t know aboutthe way our body and mind are connected,” Hubert says.

Neuenschwander recently began arestorative yoga therapy that she considers a very deep type of meditation.Propped into various poses for morethan 30 minutes at a time, participantscan relax all of their muscles deeply.“The relaxation is even deeper thanwhen you’re asleep,” Neuenschwander

says. “During the first 10 minutes it’shard to quiet your mind. Your grocerylist pops into your head,” she says. Buther thoughts settle in the second 10 minutes. “Then after about 20 minutesyour muscles just melt like butter,” she says.

Mindfulness can be a powerful tool forcontrolling your reactions to situationsand limiting stress—and that can benefiteveryone, whether they have chronicpain or not. “There are so many thingsin your life you have no control over,”Neuenschwander points out. “If you canlook at a traffic jam as just a bunch ofcars, it makes it much easier to getthrough life.”

4

Taking Life Moment by Moment: Meditation and Chronic Pain C O N T I N U E D F R O M P A G E 3 . . .

Mindfulness can be a powerful tool for controlling your reactions to situations and limiting stress—and that can benefit everyone, whether they have chronic pain or not.

| TOP |

5

Mindfulness is About Making the Minutes Matterby Alison Conte, Editor, The Chronicle

We’ve all had hours that zip by. When we are immersedin work or hobbies, chunks of the day just disappear.Then there are occasions when time grinds to a halt.

Stuck in traffic, waiting at the doctor, you wish that the min-utes would pass more quickly. Far less common is a state ofmindfulness, when we are aware of each minute of the day,cherishing life, living in the moment.

Mindfulness is at the heart of Buddhist meditation practicesthat teach followers to pay attention to the present moment—defining it as the only moment that exists, in which we exist,an ever-present “now”. Through meditation, you can learn tofocus on the present and not worry about the future or regretthe past. In letting go of day-to-day preoccupations, you are leftwith an appreciation of the big picture, the joy of being aliveright now, and the recognition of breath, mind, body, andinner spirit.

According to the Center for Mindfulness in Medicine, HealthCare, and Society, “mindfulness is a way of learning to relatedirectly to whatever is happening in your life, a way of takingcharge of your life, a way of doing something for yourself thatno one else can do for you—consciously and systematicallyworking with your own stress, pain, illness, and the challengesand demands of everyday life.”

The center teaches program participants to restore a “balancedsense of health and well being through increased awareness ofall aspects of self.”

Mindfulness for Pain ManagementPenney Cowan, executive director of ACPA, said, “Mindfulnesscan support pain management by helping you redirect yourattention off of your pain and onto things that you have morecontrol over. To do this we have to learn to listen to our bod-ies. We have to be aware of how our pain emerges, so it doesnot progress so quickly that it is impossible to regain control.” 

Pacing activities is a useful pain management technique. Butfirst we must pay attention, so that when we hear that initial“Ouch!”, we slow down and pace ourselves, to keep the painunder control.

By paying attention to our feelings—physical, emotional, and spiritual—we can anticipate pain’s arrival and prevent its acceleration. Penney said that this type of focus is essentialto practice the techniques necessary to tell our bodies how wewant them to feel. 

The goal of pain management is to increase function and quality of life while reducing your sense of suffering. Becausewe have a one-track mind, we can only think of one thing at

a time. If you are immersed in a song, a hobby, or a rich mental image, you are not thinking of pain. By redirecting your thoughts, even if only briefly, you have for that momentreduced your sense of suffering. That moment became a goodpart of your day.

Many people use relaxation, self-hypnosis, meditation, andother techniques in their day-to-day pain management. Thesemethods distract them from the pain, as they concentrate onwords, music, or imagined places that they can go to redirecttheir attention away from their pain. 

“Mindfulness is the state of turning off the chatter in your ‘gerbil brain’ and choosing what you want to experience,” saidDr. Mark Jensen, a clinician and scientist who uses and studiespsychosocial pain treatments. “We can become deeply absorbedby one thing and let everything else go into the background. Inthis state of focused awareness, we may notice the pain, but thebrain is in a state which is inconsistent with suffering, so weare less bothered by it.”

Through hypnotic suggestion, Dr. Jensen shows people how to enter the state of focused relaxation easily and develop an improved quality of life because they pay attention to the meaningfulness of life and move the minor irritations to the background.

(You can read more about using self-hypnosis to enter a relaxedstate of mind on page 7.)

Focusing on the PositiveActivities, stress, weather, food, and moods can trigger pain butwe can also learn to let pain trigger a relaxation response, deepbreathing, or a mental detour that allows us to feel the painand move away from it, focusing on something else.

C O N T I N U E D O N P A G E 6 . . . | TOP |

“Pain made me stop my rush throughlife and focus on individual things,”said Amanda Ford, a composer, teacher,singer, and musician in Pittsburgh,Pennsylvania. “Because I am hyper-sensitive to the ebb and flow of mypain, I have also experienced anincrease in my empathy for others.When I am with someone, I am presentin that moment, an active listener.”

Ford believes that people with pain aremore aware of the value of the presentmoment because they know that at anyinstant, their ability to use their time asthey want can be taken away by a flare-up of pain. “So I use my time wiselyand do things that are important to me.And I have a very low tolerance forthose who want to waste my time in trivial matters,” she said.

She remembers well a time in a hospital, between appointments, whenshe heard a harpist playing in the lobby.“That music was a light in the darkness,so appreciated because it took me awayfrom that place, and all those worries,”she said.

Ford suggests that people with pain findthe music that inspires joy for them.“Everyone has their own; it doesn’t haveto be classical,” she said.

Dr. Jensen agreed, noting that musicstimulates the sensory cortex. The rhythmic patterns in music can also bea focus, like biking, walking, or swim-ming, that helps us tune out the chatterand find a peaceful, mindful place.

6

Mindfulness is About Making the Minutes MatterC O N T I N U E D F R O M P A G E 5 . . .

Mindfulness Resources

Articles related to mindfulness can be found in past issues of The Chronicle, available online.

❋ Solutions for Sleepless Nights, June 2010 ❋ Hypnosis for Clinical Pain Management, March 2010❋ The Healing Power of Guided Imagery and The Art of

Pacing, Setting Limits and Goals, December 2008❋ The Role of Stress in Pain Management, Spring 2005❋ Music Lessens Chronic Pain, Winter 2005

“Meeting Pain with Awareness” at www.Mindful.org (contributed by ACPA facilitator Cheryl Neuenschwander.) is about body and mindfulness based stress reduction.

The Connection between Mindfulness and Pain C O N T I N U E D F R O M P A G E 1 . . .

If only we had heard that little voice when it said, “I’m not comfortable. Take a five-minute break, please.” By taking a break before the pain is overwhelming, we can pace our activities and control the pain.

It is very difficult when you are in pain to believe that it is not all physical. The more we think about our pain the more we suffer. But, how can we stop thinking about pain when it is screaming at us and controlling our lives?

Mindfulness Helps You Gain ControlThat is where mindfulness enters the picture as a significant component to living with pain as a person. Not only can you learn to listen to your body, you can—withpractice—tell your body how you want it to feel. You can regain control, somethingeveryone with pain wants: to control your life again and put pain in the back seat.

Mindfulness is one of the top techniques required to manage pain. In this issue, we will explore what mindfulness is, how to listen to our bodies, and use mindful meditation and self-hypnosis to reduce stress and tension. Most importantly, by beingmindful of our bodies and emotions, we can manage the fear of being out of control,put pain in its place, and be in command of our own lives.

| TOP |

7

Hypnosis is based on a single simple idea: when peoplefocus their attention and become very absorbed on asingle object, they are more able to change how they

feel. Virtually any absorbing activity can induce the state ofrelaxed yet focused awareness associated with hypnosis.

You need not worry about getting “stuck” in a hypnotic state. In fact, you should find that the state of focused awareness feelsvery familiar to you. Have you ever sat on a beach watching asunset while on vacation or engaged in some interesting andabsorbing hobby? You might sometimes lose track of time inthese situations, but you do not get “stuck” in them. When it istime for you to return to your usual day-to-day state of mind,you will do so.

What Is a Hypnotic Induction?The hypnotic induction is the first step in any self-hypnosis orclinician-led hypnosis session. The classic stimulus that manypeople have seen in old movies and cartoons is a swingingpocket watch, but virtually any object can be used, such as acandle, a spot on a wall, the clinician’s voice, or even your ownbreathing. It could also be some image that you generate your-self; like an image of being in some safe and relaxing place.

When people focus their awareness in this way, changes happenin the brain. There is an overall decrease in activity—the braincalms down. During this experience, the part of the brain thatkeeps track of time can become so inactive that you might

lose track of time. The nerve cells in the part of the brain that prompt feelings of worry or anxiety are less active, so you feel less anxious during and after a hypnotic induction. As a result of these brain activity changes, people often respond to hypnotic inductions by feeling more calm andrelaxed, and also more focused.

You may sometimes choose to use the induction to simply getinto a hypnotic “state,” given that you will likely find the staterelaxing and very comfortable, not unlike meditation. Enteringthis state has many positive health benefits on its own.

However, you can also follow your self-guided induction withself-suggestions for reduction in your pain and improvement inyour mood or to your sleep.

Because sleep problems are so common in people with chronicpain, and because self-hypnosis can be so helpful for improvingsleep quality, the rest of this article will focus on the use of self-hypnosis for improving sleep. (You can find more informationon using self-hypnosis for managing your pain, mood, and evenyour thoughts and behavior in Hypnosis for Chronic PainManagement: Patient Workbook, published by OxfordUniversity Press*.)

Getting Ready to Slip into SleepUsing a hypnotic induction can help you get to sleep faster,stay asleep longer, and feel more rested when you wake up.

Virtually any time you focus your awareness on a stimulus or image, the brain’s response is to decrease fast-wave (beta)activity and increase slow-wave (alpha and theta) activity. Thereis less “chatter” in the mind; you are too busy noticing thedetails of your safe place or experiencing feelings of relaxationto worry and ruminate. From this state, if the brain and bodyneed sleep, you will more easily slip into sleep.

For some people, a natural muscular response to relaxation isto “twitch.” This is a sign that you are relaxing. You might findit interesting to count the twitches, but don’t be surprised ifyou can’t. This inability to count and keep track is another sign that your brain is drifting into the first stages of sleep.

A second experience sometimes associated with drifting off to sleep is that of random visual images—either “dreamlike”images of objects or people, or simply colors and patterns. If you experience these images, your job is to simply notice and enjoy them as they occur, and to understand that they

Self-Hypnosis Techniques for Management of Pain, Relaxation, and Sleep

by Mark P. Jensen, Ph.D.

C O N T I N U E D O N P A G E 8 . . . | TOP |

8

Self-Hypnosis Techniques for Management of Pain, Relaxation, and SleepC O N T I N U E D F R O M P A G E 7 . . .

are a sign that you are getting control over the process of getting to sleep. Focusing on these images will keep you fromfocusing on your thoughts, helping you to get to sleep faster.

When you wake up in the middle of the night—and mostadults, in particular older adults, do—you can simply use your favorite hypnotic induction to get your mind into a state where it is easy to get to sleep again.

Self Hypnosis Induction TechniquesIn teaching people hypnosis inductions and in the workbook*, I offer three typical techniques that give you something interesting to focus on as your mind slows down.

These detailed scripts are modeled on the inductions used in our research on hypnosis and chronic pain management—studies that support the efficacy of hypnosis treatment forchronic pain. Therefore, they can be viewed as inductions that have scientific support.

However, everyone is different and you will likely find that you respond better to some inductions than to others. You may modify the inductions to make them even more effectivefor you. If you are working with a clinician experienced in the use of hypnosis, he or she will also work with you to find thehypnotic inductions that are most effective.

It is a good idea to begin each induction with a deep and satisfying breath; hold it for 5 to 10 seconds and then let it go.It takes advantage of the fact that there is a natural relaxationresponse that follows an exhalation. You will associate the cuewith your own hypnotic response. The following are summariesof these techniques; more details are in the workbook mentioned at the end of the article.

The Countdown In the countdown induction the script suggests you slowlyimagine yourself going down an elevator. You can imagine the numbers appearing in your mind’s eye.

As you count from one to 10, take a deep, satisfying breath,hold it, and then let it all the way out. Imagine that you feelyourself settling down, one level of comfort at a time, into adeeper and deeper experience of comfort and relaxation. Whenyou reach the tenth level, you can really enjoy an experience ofdeep, comfortable ease.

Once you reach the number 10, you can then enjoy the feelingsof relaxation that you have created for yourself for as long asyou wish. Just a couple of minutes would be fine if you are

taking a short break. Many people choose to stay in this statefor 5 or 10 minutes, as they find it so calming and relaxing.

RelaxationRelaxation inductions are useful for individuals with chronicpain because the mental calm that often accompanies relax-ation is inconsistent with the suffering sometimes associatedwith pain. People with chronic pain who learn to experiencerelaxation whenever they wish often feel less pain and less distress associated with their pain.

In this induction, you focus on different parts of the body and different muscle groups, allowing each part to relax insequence. Simply allow your mind to move from one body partto the next, letting each body part feel relaxed before movingon. Notice the specific sensations that you feel as your bodyrelaxes. Is it heaviness, warmth, lightness, a slight tingling,something else? Whatever the sensations are for you, you shouldpay attention to those sensations and allow them to grow.

To facilitate the relaxation induction, you can use the relaxation video on the ACPA website, or purchase relaxationtapes and CDs from the ACPA store.

Going to a Safe PlaceThis induction takes advantage of many people’s ability toimagine themselves in a specific location. If you can imagineyourself in a place where you feel very safe and comfortable—and picture in your mind’s eye the details of that place—thenfeelings of relaxation and comfort will naturally follow theimages that you create.

Safe place inductions and suggestions are particularly useful forindividuals who have a talent for imagery and who are able tovisualize a place in enough detail so that the feelings associatedwith the place are elicited automatically.

It is also useful to include all of the senses when imagining thesafe place. To smell the smells (for example, the salty air at abeach), hear the sounds (the rush of water in a meadow next toa mountain stream), and feel the textures (sand or dirt outside)and temperature. You may find that some senses help you toexperience being in your safe place more easily than other sensations. If so, it would be wise to focus on those senses asyou enter your place and experience yourself being there.

3-2-1 TechniqueI learned about an excellent self-hypnosis induction—the “3-2-1”technique—from a colleague and clinician named Björn Enqvist.

| TOP |C O N T I N U E D O N P A G E 9 . . .

9

Members’ ForumAn Essay to Mr. Pain

Jeanne Spring, facilitator of the Nevada County ACPA support group,

asked the members to write a letter to “Mr. Pain.” They described

what pain has done to each of them and the hold that it has on them.

They used the opportunity to describe everyday battles and successes

and speak directly to their pain. Here is one of their stories.

Attention Mr. Pain,

This letter is to inform you that I am taking my life

back. Under your stewardship, my life fell apart

and became a living nightmare for years. You were

unrelenting in making me as miserable as was in your

power to do so. I allowed you to do this. However,

I am no longer empowering you. I have chosen life

instead. I have cast aside the label of “pain patient”

to become a person once again, as it is my birthright.

Our relationship deteriorated from you being a friendly

messenger of bad news, through becoming a persistent

harasser, to becoming the bad news itself. You crossed

the line as to what our relationship was intended to

be. Your adamant insistence that I give you exclusive

attention 24/7 was way over the top. While I tolerated

with my passivity, I am no longer so tolerant.

I have learned to manage you better, listened to your

initial whining complaints in my body, and taken

prompt action to quell your outrage. We remain

partners—for life—but it is appropriate that I retain

the upper hand. I promise to be more attentive to

your initial protests and to keep my body within

the limits of the stress it can endure. I ask for your

cooperation in this matter to reestablish a

reasonable balance.

— Gary Ahlstrom

The 3-2-1 technique is very simple. First, just listen for threethings. Any three things that you hear as you are going to sleepwill do: the noise of your breathing—one; a sound of a far-offairplane—two; or maybe the sound of your skin against thesheet—three.

Next, feel three things. For example, the feeling of the sheetagainst your skin—one; an interesting tingling sensation in yourarms—two; and cool or warm air on your face—three. Just feelthem and count them, 1, 2, 3.

And then, see three things. Allow three images to come into themind. Just let them appear, on their own. A rose—one. A bluesky—two. Some third image; it does not matter what it is,maybe a beach—three. Any three images.

Then, after you have seen the third thing, go back and hear two things, and count them in your mind. Then feel twothings. Then see two things. Then hear one thing, feel onething, and see one thing.

And then start again. Hear three things, feel three things, seethree things. Then hear two things, feel two things, see twothings. Then hear, feel, and see one thing. And back to three.

As the mind focuses on and is experiencing what it hears, feels,and sees, and as it starts to drift to sleep, you will likely losecount. That is fine; just start over. You can use this strategy anddiscover what interesting things you can experience as you driftinto a deep, restful sleep.

Using Self-HypnosisOnce you learn to create a hypnotic state for yourself—a statewhere the mind is relaxed and you feel more comfortable—you can practice it on a regular basis. Research shows that thebeneficial effects of self-hypnosis can last for hours after youpractice, even if you practice for just one or two minutes at atime. By allowing yourself to experience the hypnotic statemany times during the day, you will become better at usinghypnotic skills and can feel much better as a result.

* Much of the information presented in this article is a summary of

portions of “Hypnosis for Chronic Pain Management: Patient

Workbook” by Mark P. Jensen, published by Oxford University Press.

This workbook is available from Amazon.com. Dr. Jensen is a

University of Washington professor and vice chair for research

of the Department of Rehabilitation Medicine.

| TOP |

C O N T I N U E D F R O M P A G E 8 . . .

10

Why Attitude Mattersby John Yeoman, M.A. LMHCA, ACPA facilitator, Snohomish County, Washington

The only disability in life is a bad attitude.~ Scott Hamilton

Does attitude matter? Does living with chronic pain evergive you an attitude problem? According to Merriam-Webster’s dictionary, attitude is commonly defined as

a “mental position with regard to fact or state.” I know whenI’m overwhelmed by pain my mental position is in a state! And that’s a fact!

Most of us know the daily struggles of chronic pain that mayleave us frustrated or overwhelmed. Pain issues can slightlychange or dramatically shift our attitudes.

Pain can change attitudes. However, staying aware of ourmoods and practicing meditation or relaxation techniques can be very effective in reversing pain-itude (pain that puts onein a bad mood). Understanding pain’s influence on our moodis important, but what about our attitude’s influence on pain?

Have you ever been near happy or excited people and their joywarms your day? Is happiness contagious? In my experience,I’ve noticed that when people are positive or excited, theirinfluence can be potent. When I’m close to a motivated person,I feel their motivation.

My mother used to say, “Laugh and the world laughs with you.” And when I venture out with a wide smile, I can oftensee smiles reflecting mine. Like dominoes: one smile starting a great chain reaction. If a happy stranger can influence our day in small or even dramatic way, imagine the effect our own attitude can have. Negative attitudes can isolate us, while positive attitudes reach out beyond us.

We have a lot of power! The amazing ability of our positiveattitude provides the body with drive to heal, just as a negative attitude can take the body’s healing ability away.

In his book, Excuses Begone, Dr. Wayne Dyer sums up this complex idea by stating, “Your perceptions have the power tochange your genetic makeup—your beliefs can and do controlyour biology.” Many great examples, studies, and books haveillustrated how powerful this idea is and just how influentialour outlook on life can be.

So the challenge is, as always, to choose our attitude; instead of allowing pain to determine how we view the world. By using knowledge of healthy living and focusing on abilities (not disabilities), our attitude will not become so easily lost in the haze of pain.

By reaching beyond the pain to a positive outlook we canincrease health and trigger a contagious happiness. The attitudethen becomes a beacon of support reflecting back from thosearound us.

Does your attitude matter? Yes! And an infectious attitude cancreate a path of smiles to health and support.

Written by John Yeoman ©2011. John has been a facilitator for the

ACPA for nine years, teaches pain management classes at the YWCA,

and peer support groups at the VA. 

| TOP |

11

Book Review

The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing, and the Science of Suffering by Melanie Thernstrom

Review by Tara White, RN

This is simply the best, most readable, most thorough, andenjoyable pain book I have ever read. Melanie Thernstrom captures your attention from the first page in her meticulouslyresearched masterpiece. She grabs hold of you, just as paindoes; only you don’t want this pain thriller to end.

I wanted to shout, “Yes! This is how I feel!” I wanted my husband, my mother, and my daughter to read it—to trulyunderstand what living with chronic pain is all about. I wanted to hand it to all the well-meaning people who ask “Are you feeling better yet?” or “But, you look so good.”

How do you explain that the pain is within, part of you,redefining and reshaping all you think and do? Yet it is invisible. It has tethered itself to you and it plans to stay.

Melanie Thernstrom writes with incredible insight and gracefuleloquence about the invisible intricacies of the pained mind.

She begins with potent and thought-provoking metaphors that capture the essence of true chronic and unending pain.She says pain is “this unhappy country on whose shores wehave washed up after a voyage upon which we never sought to embark.”

“A landscape where nothing looks entirely familiar and whereeven the familiar takes on an uncanny strangeness” describeour lives only too well. Furthermore, she compares pain to “a sour domestic partner—intimate and ugly; a threatening,dirtying, distracting presence, yet one who refused to moveout.” These forceful analogies become vivid images to ponder.

Functional and scientific explanations of pain pathways areinteresting, basic yet informative enough for every level. One is left creatively entertained and truly inspired.

Throughout the book, we get a smattering of Thernstrom’s own personal pain journey and only hidden in the acknowl-edgements do we learn her beautiful and enduring destination. Beginning as an intermittent and lingering neck and shoulderswimming injury, Melanie’s pain becomes angry and chronic.

Numerous physicians cannot diagnose her injury and prescribetreatments that sometimes even cause her more pain. She liveswith self-doubt and loathing, always questioning herself. Sheultimately uses her skills as a writer to research pain and various relief methods used throughout history: spiritual, religious, and cultural beliefs, and technological discoveries.

This book acknowledges that despite the great strides beingmade, medicine still cannot always “fix it.” Pain remains a mystery, a puzzle with never-ending pieces that must be located and formed into some shape to comprehend. Some of us fight and deny; others simply find ways to endure.

The author reveals some truly terrifying components of pain.

❋ The central nervous system rewrites itself over time causing permanent pain messages to travel from the injury site.

❋ Cognition can be affected as parts of the brain have actually been damaged.

❋ The hormones that regulate the way the brain deals with pain are the same as those that impair immunity, meaningthat the immune function is impaired.

❋ Cortisol increases, causing abdominal weight gain with all of its associated dangers.

❋ Pain causes the brain to atrophy, especially those areas that regulate the awareness of pain. Not only does the painbecome more irreversible, it also becomes less responsive to therapy.

Luckily, the author notes, pain is now recognized as a diseaseitself rather than just a symptom. This new pain perspectivehas opened up a whole new paradigm of thought and research.As a consequence, this book states, there is now tremendoushope for pain practitioners and people with pain alike.

The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries,

Brain Scans, Healing, and the Science of Suffering; author, Melanie

Thernstrom; Farrar, Straus and Giroux New York, 364 pages, $27

| TOP |

12

Medical and Research NewsThe messenger, cAMP, relays responsesand mediates the action of many bio-logical processes, including inflamma-tion and cardiac and smooth musclecontraction.

The research, done on rodents, confirmed earlier studies at UC Davis that showed that pain can be reducedby stabilization of natural epoxy-fatty acids (EFAs) through inhibition of sEH.“However, in the absence of an under-lying painful state, inhibition of sEH is ineffective,” lead researcher BoraInceoglou said.

“This permits normal pain responsesthat serve to protect us from tissuedamage to remain intact, while alleviat-ing debilitating pain,” said co-authorand pain neurobiologist Steven Jinks.

Details are available at the UC DavisDepartment of Entomology website.

Practice Guidelines for NeurologistsThe American Academy of Neurology(AAN) develops clinical practice guide-lines to assist its members in clinicaldecision making related to the preven-tion, diagnosis, treatment, and prognosisof neurologic disorders. Each guidelinemakes specific practice recommendationsbased upon a rigorous and comprehen-sive evaluation of all available scientificdata.

Physicians and medical professionals can review and search the guidelines at www.aan.com/guidelines

Research into Pain PathwaysReveals Interactions Researchers at the University ofCalifornia, Davis have discovered a “cross-talk” between two major biological pathways that involve pain research that may pave the way to new approaches to understanding and controlling chronic pain.

The newly published research reveals that analgesia mediated by inhibitors of the enzyme soluble epoxide hydrolase(sEH) is dependent on a pain-mediating second messenger known as cyclicadenosinemonophosphate or cAMP.

In each issue of The Chronicle, this column will share communications between the ACPA and U.S. veterans andservice members living with chronic pain. We welcome

your feedback at jani@vetsinpain.org.

To keep you better informed, the ACPA has created an entirewebsite dedicated solely to veterans and service members. Visit it at http://www.vetsinpain.org. There are articles, news of interest, and links to helpful resources.

Peer Support Available to AllThe Veterans In Pain program is planning a virtual pain management peer support meeting for veterans, which will let U.S. veterans from all around the country log in and attenda meeting via their computers.

We are currently in the testing stages of this virtual meeting,trying it out with the ACPA facilitators who work with veteransand service members.

The functionality is huge! We have the ability to show demon-strations, videos, and presentations, providing veterans with the tools they need to start living a more productive life. We will also be able to open up the virtual rooms for two-wayconversations, questions, and feedback.

At ACPA VIP we pride ourselves on serving smaller groups—giving a personal touch to our program. Extra care and attention will given to every question or comment we receive,which will help us better understand you.

While our virtual conference room will let us relate to anyonewho is unable to make a meeting, we should emphasize thatattending a physical support group meeting is preferred, asnothing can take the place of human contact.

Watch for more information coming soon. We look forward tomeeting everyone in the future, in these virtual meeting roomsof the future, or in person.

For Our VIPs: Veterans In Painby Jani Larsen

| TOP |

| TOP |

13

ACPA Updates

k

Government Announces REMS to Combat Drug Abuse On April 15, 2011, the Obama administration released details of a plan to address prescription drug abuse, requiring drugmakers to develop education programs about the safe use ofopioids.

The new strategy is intended to prevent drug diversion and protect delivery of effective pain management through new federal requirements. The plan:

❋ supports the expansion of state-based prescription drug monitoring programs

❋ recommends more convenient and environmentally responsible disposal methods

❋ supports education for consumers and healthcareproviders, and

❋ reduces the prevalence of pill mills and doctor shoppingthrough enforcement efforts.

The FDA’s Opioids Risk Evaluation and Mitigation Strategy(REMS) will require manufacturers of long-acting and extended-release opioids to provide educational programs for prescribers and for consumers.

You can read more on the ACPA website, http://www.theacpa.org/newsDetail.aspx?id=33 or replay astakeholder’s call (held April 20, 2011) with several directors of the FDA, during which they discussed details of the FDA’snew safety measures. Call 1-866-463-4969 (203-369-1404 for international callers) before June 20, 2011.

For more about the implications of the FDA’s plan and ACPA’sefforts to raise awareness of these issues, read The Chroniclearchives: December 2010, page 8, “ACPA in Partnership to RaiseAwareness about Prescription Medicine Abuse” and June 2010,page 8, “REMS: Fighting Drug Abuse or Limiting Access” athttp://www.theacpa.org/60/Chronicle.aspx.

Pain Curriculum Educates Medical StudentsTufts University’s program in pain research, education, and policy celebrated 10 years of graduating students in the first andonly multidisciplinary postgraduate pain curriculum of its kindin the United States. The program has enrolled nurses, physi-cians, dentists, physical therapists, nurse practitioners, pharma-cists, researchers, acupuncturists, occupational therapists, hos-pice workers, health policy advocates, and other professionals.

Its curriculum addresses topics such as the ethical and sociocultural aspects of pain, palliative care, end-of-life issues, public policy, legislative issues, communication, research methods, and advocacy, along with clinical issues and the neurochemistry of pain. Its director, Dr. Daniel Carr, is a member of the ACPA’s Medical Advisory Board. You can learn more about this innovative program atwww.tufts.edu/med/education/phpd/msprep

Communications Tools Targeted to Health Care ProfessionalsMedscape, which offers continuing education courses for physicians and nurses, is now working with ACPA to providecommunications tools to help health care providers communi-cate more effectively and efficiently with people with chronicpain and others. A direct link to ACPA materials can now befound under Patient Assessment and Educational Materials on the Medscape Professional Pain Collaborative website,http://www.medscape.org/resource/pain/cme

New Interactive Pain LogStress, sleep, money worries, and even the weather can affectpain. The ACPA Pain Log can help you track and understandwhat makes your pain worse, so you can work on ways to dealwith your pain triggers. The more you know about how yourbody reacts, the more you can be in control, less afraid, andbetter able to manage pain.

The online pain log lets you fill out a chart at the end of eachday or several times a week. You can also take your log book toyour doctor visits. It can help you talk more openly with yourhealthcare providers. Visit our new Interactive Pain Log at:http://www.theacpa.org/25/CommunicationTools.aspx

Time Magazine Reports on Pain TreatmentsThe March 7, 2011, issue of Time Magazine contained severalfeature stories about understanding pain. It discussed drugtreatments, spinal cord stimulation, and acupuncture andshared several stories of people living with pain. In his column, Dr. Mehmet Oz stated that “physicans can predict apain diagnosis related to injury, but are otherwise workinglargely in the dark, reliant on patient narrative.”

He urged people with pain to preapre for their appointmentsso they can ask the right questions, adding “The AmericanChronic Pain Association has a great list of communicationtools to help you better verbalize your pain.”http://www.time.com/time/health/article/0,8599,2057269,00.html

| TOP |

14

| TOP |

Since 1980, the American Chronic PainAssociation has provided people who must live with daily pain a means to help themselves to a richer, fuller life. We are grateful to have the support of these corporate sponsors for our mission.

AMBASSADORLillyMillennium Laboratories Endo PharmaceuticalsPfizer

EDUCATORCephalon Forest Laboratories Inc.Medtronic, Inc. Purdue

BUILDERAbbott Archimedes PharmaPriCara

Thank you to these corporations for grantsthat enabled ACPA to fund special projects.

Pfizer for the fibromyalgia education campaign

Medtronic and Purdue Pharma for an unrestricted educational grant to develop the new ACPA website

Forest Laboratories for the fibromyalgiaWeb-based interactive person

Medtronic for the Understanding Medical Devices Video

The Chronicle is published quarterly by the AmericanChronic Pain Association.

We welcome essays, poetry, articles, and book reviews written by people with chronicpain or their families.

Please send inquiries to:

The ACPAP.O. Box 850Rocklin, CA 95677

Executive Director:

Penney Cowa n

President,

Board of Directors:

David Provenzano, M.D.

Past President,

Editorial Director:

Nicole Kelly

Medical Editor:

Steven Feinberg, M.D.

Copy Editor:

Alison Conte

Special Features:

Erin Kelly

Welcome to our newgroups and facilitators.

Karen JanzenWichita, KS

Carrie Miller BiggersNortheast, MD

Cherith MooreColumbia, MO

Steve McDanielsLas Cruces, NM

Rita-Marie GearyRochester, NY

TributesHonor Someone Special for PainAwareness Month

In Memory of

Carol Brown

Mother of Deborah Bartucca

Given by Mr. & Mrs. Donal Flintzer of Delray Beach, FL

In Memory of

Joanne Echols

Given by Hunter Quackenbush

Thank You!

Many people support those of us who live withchronic pain, including doctors, therapists, and loved ones. For September, Pain AwarenessMonth, honor the unsung heroes in your life by making a donation to the ACPA. We will recognize these special people in the September issue of The Chronicle. Donate through the form on page 15, or online.

The ACPA is a peer support organization: we help each otherlearn to live fully in spite ofchronic pain. Your membership,donations, and purchase of materials keep the ACPA alive and reaching out to even morepeople with pain.